Hipotrofia de membro inferior como complicador no pós-operatório de fratura de tornozelo / Lower limb hypotrophy as complicating factor in the postoperative of ankle fracture

As fraturas de tornozelos são lesões muito comuns do sistema musculoesquelético, provocando grandes repercussões sobre a sua função, podendo gerar desarranjos articulares como instabilidade, limitação de movimento, incongruência articular e artrose secundária (pós-traumática). A imobilização pós-fratura gera efeitos adversos, como contratura articular e hipotrofia/atrofia muscular e óssea. Trata-se de um relato de caso, realizado na Policlí­nica e Centro de Estética Duque de Caxias (Clí­nica Escola da Unigranrio), com um paciente do sexo masculino que sofreu fratura de tí­bia e fí­bula distais em membro inferior direito. Foram avaliados o grau de amplitude da articulação tibiotalar, o grau de força muscular, a perimetria e a intensidade da dor. O objetivo deste estudo foi o de demonstrar a importância da realização da perimetria de membros inferiores pós-fratura de tornozelo como fator que predispõe a complicações osteomioarticulares, não sendo este fator motivo de queixa do paciente. Concluiu-se que como diversos estudos comprovam a existência da hipotrofia pós-fratura, a mensuração da perimetria torna-se importante fator de prevenção de possí­veis disfunções compensatórias do aparelho osteomioarticular. (AU)

Fractures of ankles are very common injuries of the musculoskeletal system, causing major repercussions on their function and can cause joint disorders such as instability, limitation of motion, joint incongruity and secondary osteoarthritis (post-traumatic). Immobilization post fracture generates adverse effects such as joint contracture and muscle and bone atrophy. This study is a case report conducted at the Polyclinic and Aesthetic Center Duque de Caxias (Unigranrio School Clinic), with a male patient who suffered fracture of tibia and distal fibula in the right lower limb. We evaluated the degree of amplitude of tibiotalar joint, the degree of muscle strength, girth and pain intensity. The objective was to demonstrate the importance of holding the perimeter of ankle after fracture legs as a factor that predisposes to musculoskeletal complications, not being this factor, patient grievance. It was concluded that as many studies show the existence of post-fracture atrophy, measuring the perimeter becomes important factor in preventing possible compensatory dysfunctions of the musculoskeletal system. (AU)

Within-breath respiratory impedance and airway obstruction in patients with chronic obstructive pulmonary disease

OBJECTIVE: Recent work has suggested that within-breath respiratory impedance measurements performed using the forced oscillation technique may help to noninvasively evaluate respiratory mechanics. We investigated the influence of airway obstruction on the within-breath forced oscillation technique in smokers and chronic obstructive pulmonary disease patients and evaluated the contribution of this analysis to the diagnosis of chronic obstructive pulmonary disease. METHODS: Twenty healthy individuals and 20 smokers were assessed. The study also included 74 patients with stable chronic obstructive pulmonary disease. We evaluated the mean respiratory impedance (Zm) as well as values for the inspiration (Zi) and expiration cycles (Ze) at the beginning of inspiration (Zbi) and expiration (Zbe), respectively. The peak-to-peak impedance (Zpp=Zbe-Zbi) and the respiratory cycle dependence (ΔZrs=Ze-Zi) were also analyzed. The diagnostic utility was evaluated by investigating the sensitivity, the specificity and the area under the receiver operating characteristic curve. ClinicalTrials.gov: NCT01888705. RESULTS: Airway obstruction increased the within-breath respiratory impedance parameters that were significantly correlated with the spirometric indices of airway obstruction (R=−0.65, p<0.0001). In contrast to the control subjects and the smokers, the chronic obstructive pulmonary disease patients presented significant expiratory-inspiratory differences (p<0.002). The adverse effects of moderate airway obstruction were detected based on the Zpp with an accuracy of 83%. Additionally, abnormal effects in severe and very severe patients were detected based on the Zm, Zi, Ze, Zbe, Zpp and ΔZrs with a high degree of accuracy (>90%). CONCLUSIONS: We conclude the following: (1) chronic obstructive pulmonary disease introduces higher respiratory cycle dependence, (2) this increase is proportional to airway obstruction, and (3) ...

Contrasting diagnosis performance of forced oscillation and spirometry in patients with rheumatoid arthritis and respiratory symptoms

OBJECTIVES: Pulmonary involvement in rheumatoid arthritis is directly responsible for 10% to 20% of all mortality. The best way to improve the prognosis is early detection and treatment. The forced oscillation technique is easy to perform and offers a detailed exam, which may be helpful in the early detection of respiratory changes. This study was undertaken to (1) evaluate the clinical potential of the forced oscillation technique in the detection of early respiratory alterations in rheumatoid arthritis patients with respiratory complaints and (2) to compare the sensitivity of forced oscillation technique and spirometric parameters. METHODS: A total of 40 individuals were analyzed: 20 healthy and 20 with rheumatoid arthritis (90% with respiratory complaints). The clinical usefulness of the parameters was evaluated by investigating the sensibility, the specificity and the area under the receiver operating characteristic curve. ClinicalTrials.gov: NCT01641705. RESULTS: The early adverse respiratory effects of rheumatoid arthritis were adequately detected by the forced oscillation technique parameters, and a high accuracy for clinical use was obtained (AUC.0.9, Se = 80%, Sp = 95%). The use of spirometric parameters did not obtain an appropriate accuracy for clinical use. The diagnostic performance of the forced oscillation technique parameters was significantly higher than that of spirometry. CONCLUSIONS: The results of the present study provide substantial evidence that the forced oscillation technique can contribute to the easy identification of initial respiratory abnormalities in rheumatoid arthritis patients that are not detectable by spirometric exams. Therefore, we believe that the forced oscillation technique can be used as a complementary exam that may help to improve the treatment of breathing disorders in rheumatoid arthritis patients.

Forced oscillation technique in the detection of smoking-induced respiratory alterations: diagnostic accuracy and comparison with spirometry

INTRODUCTION: Detection of smoking effects is of utmost importance in the prevention of cigarette-induced chronic airway obstruction. The forced oscillation technique offers a simple and detailed approach to investigate the mechanical properties of the respiratory system. However, there have been no data concerning the use of the forced oscillation technique to evaluate respiratory mechanics in groups with different degrees of tobacco consumption. OBJECTIVES: (1) to evaluate the ability of the forced oscillation technique to detect smoking-induced respiratory alterations, with special emphasis on early alterations; and (2) to compare the diagnostic accuracy of the forced oscillation technique and spirometric parameters. METHODS: One hundred and seventy subjects were divided into five groups according to the number of pack-years smoked: four groups of smokers classified as <20, 20-39, 40-59, and >60 pack-years and a control group. The four groups of smokers were compared with the control group using receiver operating characteristic (ROC) curves. RESULTS: The early adverse effects of smoking in the group with <20 pack-years were adequately detected by forced oscillation technique parameters. In this group, the comparisons of the ROC curves showed significantly better diagnostic accuracy (p<0.01) for forced oscillation technique parameters. On the other hand, in groups of 20-39, 40-59, and >60 pack-years, the diagnostic performance of the forced oscillation technique was similar to that observed with spirometry. CONCLUSIONS: This study revealed that forced oscillation technique parameters were able to detect early smoking-induced respiratory involvement when pathologic changes are still potentially reversible. These findings support the use of the forced oscillation technique as a versatile clinical diagnostic tool in helping with chronic obstructive lung disease prevention, diagnosis, and treatment.

Técnica de oscilações forçadas na avaliação funcional de pacientes com fibrose cística com idade superior a 18 anos / Forced oscillation techinique for the functional evaluation of cystic fibrosis patients older 18 years

Objetivo: o objetivo deste estudo foi investigar as alterações nas propriedades resistivas e reativas do sistema respiratório de pacientes com fibrose cística. Metodologia: o estudo foi realizado em um grupo controle de 23 indivíduos saudáveis, e em um grupo de 27 pacientes com fibrose cística com idade maior que 18 anos que foram avaliados pela FOT e espirometria. Resultados: os pacientes com fibrose cística apresentaram aumento significativo (p<0,0001) na resistência total do sistema respiratório (R0), redução significativa do coeficiente angular da curva de resistência (S) (p<0,0006) e na complacência dinâmica (Cdin, sr) (p<0,0001) em comparação aos indivíduos saudáveis. Conclusão: os resultados do presente estudo são coerentes com a fisiopatologia da fibrose cística. A FOT descreveu adequadamente estas alterações, demonstrando elevado potencial na avaliação da mecânica pulmonar de pacientes com fibrose cística com idade superior a 18 anos.

Introduction: The aims of this study were (1) to investigate the changes in resistive and reactive properties of the respiratory system of cystic fibrosis patients older than 18 years and (2) assess the contribution of the forced oscillation technique (FOT) in the diagnosis of cystic fibrosis. Methodology: The study was conducted in a control group of 23 healthy individuals and a group of 27 cystic fibrosis patients older than 18 years who were assessed by the FOT and spirometry. Results: Cysticfibrosis patients presented increased total respiratory resistance (R0) (p <0.0001) and reduced slope of resistance curve (S) (p<0.0006) and dynamic compliance (Cdyn,rs) (p <0.0001) compared to healthy individuals. Conclusion: The results of thisstudy are consistent with the pathophysiology of cystic fibrosis. The FOT adequately described these changes, showing great potential in assessing pulmonary mechanics of patients with cystic fibrosis with age over 18 years.

Influence of the ageing process on the resistive and reactive properties of the respiratory system

INTRODUCTION: In an increasingly old society, the study of the respiratory system changes and new techniques dedicated to older patients are of interest in physiologic studies as well as in the diagnosis of respiratory diseases. OBJECTIVES: (1) To investigate the impact of ageing on the resistive and reactive properties of the respiratory system, and (2) to compare the easiness of accomplishment of spirometry and forced oscillation for assessing lung function. METHODS: We conducted a cross-sectional study in which forced oscillation was used to investigate respiratory system resistive and reactive properties, while spirometry was used as a reference test to evaluate 80 normal subjects aged between 20 and 86 years. A questionnaire was used to evaluate the easiness of accomplishment of spirometry and forced oscillation. RESULTS: There was a significant increase in the respiratory system resonance frequency (p<0.003) and a reduction in the mean reactance (p<0.004) with increasing age. Respiratory system resistance and dynamic compliance were not related to the ageing process. The easiness of accomplishment of forced oscillation measurements was greater than that of spirometry. This result was particularly relevant in subjects over 70 years old (p<0.05). CONCLUSIONS: Respiratory system resistance and dynamic compliance are not modified with ageing. On the other hand, respiratory system homogeneity decreases during the ageing process. Forced oscillation is easy to perform and provides information complementary to spirometry. This technique may be a promising alternative and/or complement to other conventional exams used to evaluate older people who are unable to adequately perform spirometric tests.

Broncodilatação na DPOC: muito além do VEF1-efeito do salbutamol nas propriedades resistivas e reativas do sistema respiratório / Bronchodilation in COPD: beyond FEV1-the effect of albuterol on resistive and reactive properties of the respiratory system

OBJETIVO: Atualmente existem importantes debates na literatura sobre a resposta broncodilatadora em pacientes com DPOC e se a variação do VEF1 pode ser considerada uma indicação completa de reversibilidade neste caso particular. O objetivo deste estudo foi investigar o efeito do salbutamol nas propriedades resistivas e elásticas do sistema respiratório de portadores de DPOC. MÉTODOS: Foram avaliados 70 indivíduos com DPOC, classificados através da espirometria em dois grupos: broncodilatador (BD)-negativo (n = 39); e BD-positivo (n = 31). Utilizou-se a técnica de oscilações forçadas (TOF) para avaliar os seguintes parâmetros: a resistência no intercepto (R0), associada à resistência total do sistema respiratório; a resistência média (Rm), relacionada à resistência de vias aéreas centrais; e a complacência dinâmica (Cdyn); assim como o coeficiente angular da resistência (S) e a reatância média (Xm), relacionados com a homogeneidade do sistema respiratório. RESULTADOS: O uso do salbutamol resultou em reduções significativas de R0 (p < 0,00002) e Rm (p < 0,0002). Foram também observadas elevações significativas em S (p < 0,0001), Cdyn (p < 0,0001) e Xm (p < 0,00004). Estas alterações ocorreram tanto nos dois grupos, tendo sido observadas maiores modificações nos parâmetros da TOF do que nos parâmetros da espirometria. CONCLUSÕES: O uso de salbutamol melhorou o comportamento dos componentes resistivos e reativos do sistema respiratório dos pacientes com DPOC estudados. Estas mudanças ocorreram independentemente da classificação do exame empregando o VEF1, o que indica que a utilização deste parâmetro isoladamente pode não ser suficiente para identificar completamente os efeitos fisiológicos envolvidos.

OBJECTIVE: Current debates on the bronchodilator response in COPD patients and whether the variation in FEV1 can be considered as an indicator of complete reversibility in such patients motivated us to conduct this study. The objective of the study was to determine the effect of albuterol on the resistive and reactive properties of the respiratory system in COPD patients. METHODS: We evaluated 70 patients with COPD, divided into two groups based on spirometry findings: bronchodilator (BD)-negative (n = 39); and BD-positive (n = 31). We used the forced oscillation technique (FOT) to evaluate the following parameters: resistance at the intercept (R0), associated with the total resistance of the respiratory system; mean resistance (Rm), associated with central airway resistance; dynamic compliance (Cdyn); and the slope of resistance (S) and mean reactance (Xm), both of which are associated with the homogeneity of the respiratory system. RESULTS: The use of albuterol resulted in significant reductions in (p < 0.00002) and Rm (p < 0.0002). There were also significant increases in S (p < 0.0001), Cdyn (p < 0.0001) R0 and Xm (p < 0.00004).These modifications occurred in both groups, the changes in FOT parameters being greater than those observed for spirometric parameters. CONCLUSIONS: The use of albuterol improved the resistive and reactive properties of the respiratory system of the COPD patients under study. These changes occurred regardless of the FEV1-based classification, thereby indicating that the use of this parameter in isolation might not suffice to identify the physiological effects involved.

Técnica de oscilações forçadas na avaliação funcional de crianças asmáticas / Forced oscillation technique in the evaluation of asmathic children

Objetivo: Investigar as alterações nas propriedades resistivas e reativas do sistema respiratório de crianças asmáticas e avaliar a contribuição da técnica de oscilações forçadas (FOT) no diagnóstico da asma. Metodologia: O estudo foi realizado em um grupo controle de 20 crianças saudáveis, e em um grupo de 20 crianças asmáticas, que foram avaliadas pela FOT e espirometria. Resultados: Considerando os parâmetros resistivos da FOT, houve um aumento significativo na resistência total do sistema respiratório (R0) (p<0,02) e não significativo na resistência média (Rm), além de uma redução significativa da inclinação do componente resistivo da impedância (S) (p<0,002), no grupo de crianças asmáticas. Nos parâmetros reativos a complacência dinâmica (Cdin,sr) mostrou-se significativamente (p< 0,01) menor, sendo acompanhada pela redução da reatância média (Xm) (p<0,01) e pela elevação significativa da frequência de ressonância (fr) (p< 0,03) no grupo de crianças asmáticas. Conclusão: Os resultados do presente estudo são coerentes com a fisiopatologia da asma. A FOT escreveu adequadamente estas alterações, demonstrando elevado potencial na avaliação da mecânica pulmonar de crianças asmáticas.

Objective: To investigate the alterations on resistive and reactive proprieties of the respiratory system and evaluate the contribution of the forced oscillation technique (FOT) on the diagnosis of the asthma in children. Methodology: The study was performed in a control group formed by 20 healthy children and 20 asthmatic children, which were evaluated by FOT and spirometry. Results: Considering the resistive parameters of the FOT in the asthmatic children group, the total respiratorysystem resistance (R0) had significant increase (p<0,02) and a not significant increase in mean respiratory resistance (Rm), and a significant decreased of the resistance/frequency slope (S) p<0,02). The reactive parameters, the dynamic compliance (Cdin) and the mean respiratory reactance (Xm) presented significant (p<0,01) reduction, and significant increase resonance frequency (fr) (0,03). Conclusion: The results of the present study, demonstrate that the FOT is useful for detecting the respiratory mechanics modifications. This indicate that the FOT has a high potential in evaluating respiratory mechanics of asthmatics children.

Mecânica respiratória em indivíduos tabagistas com exames espirométricos normais e com obstrução leve / Respiratory mechanics in smokers with normal spirometry and light obstruction

Introdução: o fumo irrita e lesa diretamente as vias aéreas, sendo o principal fator de risco para a doença pulmonar obstrutiva crônica. A identificação das alterações iniciais decorrentes do tabagismo é de importância clínica. Neste contexto, a Técnica de Oscilações Forçadas (FOT) tem elevado potencial de aplicação. O objetivo deste trabalho foi investigar as alterações presentes nas propriedades resistivas e elásticas do sistema respiratório associadas às alterações espirométricas decorrentes do tabagismo. Metodologia: os tabagistas foram divididos, de acordo com o grau de obstrução da via aérea avaliados pela espirometria, em dois grupos: normal ao exame espirométrico (n=12) e portadores de obstrução leve (n=22). Foram estudados também, 20 voluntários sem história tabágica ou doença respiratória e com os parâmetros espirométricos na faixa de normalidade (grupo controle). Nos ensaios de FOT, foram analisados os parâmetros relacionados a resistência total (R0), resistência relacionada as vias aéreas (Rm) e complacência dinâmica (Crs, dyn) do sistema respiratório. Resultados: foram observadas alterações significativas em todos os parâmetros obtidos pela FOT, aumentos em R0 (p<0,005) e Rm (p<0,005), e diminuição na Crs, dyn (p<0,0003). A análise entre os grupos revelou alteração significativa entre o grupo controle e o grupo tabagista com espirometria normal em Rm (p<0,015). Conclusões: o tabagismo provoca alterações na mecânica respiratória que, em sua fase inicial, são caracterizadas por elevações na resistência do sistema respiratório, principalmente na resistência associada às vias aéreas, assim como reduções na complacência dinâmica. Esses resultados confirmam o elevado potencial da FOT na avaliação das alterações de mecânica respiratória decorrentes do tabagismo.